Laparoscopic management of left thoracoabdominal stab wounds: a prospective study

Left thoracoabdominal stab wounds (LTSWs) leading to diaphragmatic injuries can cause serious morbidity and mortality. The diagnosis and treatment of LTSWs are controversial. This study investigated the reliability of laparoscopy for the diagnosis and treatment of diaphragmatic lacerations in hemodynamically stable patients with an LTSW, hypothesizing that laparoscopy is sufficient for diagnosing and treating diaphragmatic injury after an LTSW.

This study included 36 cases of LTSWs with no hemodynamic instability or abdominal tenderness seen between June 2002 and June 2007. After systemic examination and resuscitation of the patients, chest x-ray and focused assessment with sonography for trauma were carried out and then laparoscopic exploration was performed in all cases.

Of the 36 cases, 36.1% (n=13) had injuries to the diaphragm and 53.8% (7/13) had associated intraabdominal injuries. Nine (69.2%) of the patients with diaphragmatic injuries, but no hollow organ injuries, were repaired through laparoscopy. The hemopneumothorax was found in 33.3% (n=12) of the patients. No relationship was seen between diaphragmatic injuries and the location of the LTSW and existence of hemopneumothorax.

Laparotomy was required in only 11.1% (4/36) of the cases with LTSWs and 30.8% (4/13) of the cases with diaphragmatic injury. Diagnostic and therapeutic laparoscopy was a sufficient and necessary surgical procedure in cases with a hemodynamically stable LTSW, when emergency surgery (laparotomy or thoracotomy) was not necessary.